IN THE DIST.CONSUMER DISPUTES REDRESSAL FORUM BELAGAVI.
Dated this 4th day of August 2016
Complaint No. 540/2014
Present: 1) Shri.B.V.Gudli, President 2) Shri. V.S. Gotakhindi, Member
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Complainant: Sou.Sunita Ashok Ghatage,
Age: 45 years, Occ: Household work,
R/o. Manjari, Tal:Chikkodi, Dist. Belgaum
(By Sri. C.K.Kamble, Advocate)
V/s.
Opponents:1) The Manager,
LIC of India,
Branch: Chikodi,
Tal:Chikkodi, Dist. Belgaum
( By Sri.V.M.Deshapande, Advocate)
2) Sri.Suresh D.Mangalekar,
LIC Agent, R/o. Manjari,
Tal:Chikkodi, Dist. Belgaum
( By Sri.R.C.Patil, Advocate)
(Order dictated by Sri.B.V.Gudli, President)
ORDER
1) U/s. 12 of the C.P. Act, the complainant has filed the complaint against the O.Ps. alleging deficiency in service in insurance service of repudiation of claim of the complainant nominee.
2) The O.P.1 and 2 appeared through counsels. OP1 has filed written version and affidavit. OP2 neither filed his written version nor affidavit. OP-2 produced some documents
3) In support of the claim of the complaint, the complainant has filed her affidavit and produced some documents.
4) For both the parties written argument are filed. We have also heard LC for complainant and OP.1 and perused the records.
5) Now the point for our consideration is that whether the complainant has proved deficiency in service on the part of O.Ps & entitled to the reliefs sought?
6) Our finding on the point is partly in negative, for the following reasons.
:: R E A S O N S ::
7) There is no dispute that the policy holder Sri.Balasaheb Sadashiv Shinde had taken insurance policy of OP company bearing policy No.669395778 on 28.06.2013 for sum assured Rs.1 lakh and maturity date is 6/28. First premium was paid. The policyholder died on 19.07.2013 at Examba. The complainant is sister of the policy holder who is the nominee. On perusal of contents of complaint Sri.Balasaheb Sadashiv Shinde has insured his life under policy bearing No. 669395778 for sum assured Rs.1 lakh. In the said policy the complainant was mentioned as nominee of the policyholder, who is the sister of policy holder Sri.Balasaheb Sadashiv Shinde. The said policy holder died on 19.07.2013 at Examba village. The OP1 has to pay entire due amount under the policy held by Sri.Balasaheb Sadashiv Shinde to the nominee of the said policy. The complainant approached OP.1 with all the necessary documents with policy receipt and death certificate of policyholder and ID card to claim the policy amount. The OP.1 has not responded properly with the complainant even after many demands were made by complainant. Thereafter the complainat got issued legal notice on 18.01.2014 by RPAD through her advocate. The said notice served on 21.01.2014 but the OP did not replied to the said notice. Hence complainant filed the present complaint against OPs. The OP.1 refused to comply the demand notice and failed to pay the policy amount, there is deficiency of service on the part of OPs.
8) The OP.1 filed objections to the complaint filed by complainant. OP.1 has admitted that Sri.Balasaheb Sadashiv Shinde is the policyholder. On 12.07.2013 he submitted a proposal for taking insurance policy on his name for an assured sum of Rs.1 lakh commencing from back date i.e. 28.06.2013 and also admitted policy number and other contents of the policy. However the policyholder submitted a letter on 18.07.2013 for cancellation of the said policy. After receipt of the letter issued by the policyholder the policy was cancelled i.e. called as cooling off period within 15 days of cooling off period starts from the date of acceptance the said policy was cancelled. Further contended that the policyholder Sri.Balasaheb Sadashiv Shinde was suffering from severe health problems and ailments complaining about back ache, he was admitted to KLE’s Dr.Prabhakar Kore Hospital & Research Centre, Belgaum on 09.03.2013 and diagnosed as C/O D-10 D-11 Collapse #, Koch’s Eliology. After diagnosis the doctor explained to the relatives of the patient/proposer that his health condition may deteriorate and may required emergency treatment, but the patient got discharged by his relative from the hospital against medical advise. Thereafter the (policyholder) patient was admitted Sarvamangala Hospital at Miraj on 13.02.2013 till 08.04.2013. After several check-ups and investigations at Sarvamangala Hospital at Miraj (Dr.Magdum Orthopedic and Trauma Center), Shri Siddivinayak Ganapati Cancer Hospital, Dr.Sortur Hospital, Miraj it was diagnosed that Acute RES. Insufficienty/old Rt. Tubarcular Plural Effusion with Fibrosis. On perusal of documents produced by OP.1 Document.1 proposal for insurance on own health, Document.2 the letter written by policyholder Sri.Balasaheb Sadashiv Shinde regarding cancelation of his life policy on the ground that he was unable to pay the installments, hence prays for cancellation of his policy. On the basis of letter written by Sri.Balasaheb Sadashiv Shinde his policy has been called as Cooling Off cancelled. To show that Sri.Balasaheb Sadashiv Shinde was admitted to the hospital for his ailments, on perusal of summary sheet of KLE’s Dr.Prabhakar Kore Hospital & Research Centre, Belgaum policyholder Sri.Balasaheb Sadashiv Shinde was admitted to KLE’s Dr.Prabhakar Kore Hospital & Research Center, Belgaum on 09.03.2013 and on perusal of summary sheet of the doctor who has examined the patient mentioned as “patient condition may deteriorate and may require emergency treatment”, the above has been explained to the patient and patient’s relative in their own vernacular language, inspite of that they want to take back against medical advice. After Sri.Balasaheb Sadashiv Shinde was admitted on 13.02.2013 and discharged on 08.04.2013 from Sarvamangala Hospital at Miraj, the OP has produced examination records and other documents. The said doctor Sarvamangala Hospital at Miraj diagnosed as Acute RES. Insufficienty/old Rt. Tubarcular Plural Effusion with Fibrosis. On perusal of documents produced by OPs it was diagnosed that the patient was suffering from Acute RES. Insufficienty/old Rt. Tubarcular Plural Effusion with Fibrosis. On perusal of documents produced by OP1 policyholder was admitted KLE’s Dr.Prabhakar Kore Hospital & Research Centre, Belgaum on 19.02.2013 and his relative got discharged the patient against the medical advise and he was admitted to Sarvamangala Hospital at Miraj on 13.02.2013 and discharged on 08.04.2013 and he was admitted to Siddivinayak Ganapati Cancer Hospital on 22.03.2013 and discharged on 22.03.2013. On a perusal of proposal form the policyholder/ Sri.Balasaheb Sadashiv Shinde submitted his report on 12.07.2013 and policy was commencing from 28.06.2013. On a perusal of medical documents he was suffering from Acute RES. Insufficienty/old Rt. Tubarcular Plural Effusion with Fibrosis and the complainant and policyholder suppressed the disease and got life insurance policy.
9) During the lifetime of Sri.Balasaheb Sadashiv Shinde has written a letter to OP.1 for cancelation of policy. On the basis of said letter policy was cancelled as cooling off cancellation. On perusal of affidavit and objections of OP.1 after cancelation of the said policy premium amount of Rs.9,074/- was refunded to the policyholder through a cheque bearing No.2555546 dtd.02.08.2013 and the said cheque was encashed. On perusal of contents of affidavit and written version of OP.1 during the lifetime of Sri.Balasaheb Sadashiv Shinde policy was cancelled and premium amount was refunded in the name of policyholder.
10) On perusal of the contents of complaint and affidavit of complainant after death of policyholder complainant approached the OP.1 and produced necessary documents with policy receipt and death certificate of policyholder and ID Card to claim the amount due under the policy. However the complainant has not produced original policy before the forum. On perusal of the contents of written version and affidavit of OP.1, insurance policy is dtd.28.06.2013 with proposal dtd.12.07.2013. Life assured died on 19.07.2013 within 3 weeks of commencement of the policy. The policy was in existence only for a few days and canceled on the request of the policyholder. The complainant and policyholder together played fraud on the OPs. The policyholder died on 19.07.2013. Death of policy holder was not brought to the notice of OPs immediately. On the basis of canceled policy the complainant is claiming insurance amount. Already policy has been cancelled on the basis of letter written by the policyholder & the policyholder was suffering from Acute RES. Insufficienty/old Rt. Tubarcular Plural Effusion with Fibrosis without disclosing the fact of the disease he obtained the policy.
11) The complainant has failed to prove the deficiency of service on the part of OP.1.
12) Considering the entire facts, contention of parties as well as material on record complainant has not proved that repudiation of claim is unjust or illegal.
13) Taking into consideration of the facts and allegations made and after perusing the documents we pass the following
ORDER
The complaint filed by the complainant is hereby dismissed. No order as to costs.
(Order dictated, corrected and then pronounced in the open Forum on: 4th day of August 2016)
Member Member President.
msr*
